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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Pharmacological atrial defibrillation via temporarily occluded coronary sinus: first clinical experience and
G Vergara1, D Catanzariti, F Cozzi
1Division of Cardiology, S. Maria del Carmine Hospital, Rovereto, Italy.vergara@rov.aziendasanitaria.trentino.it
Insights
Pharmacological atrial defibrillation using a low-dose antiarrhythmic drug delivered to the coronary sinus proved effective in restoring sinus rhythm in most patients. This novel approach shows promise for future implantable defibrillator development.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Current treatments for AF have limitations.
- Targeted drug delivery to the coronary sinus is an emerging strategy.
Purpose of the Study:
- To evaluate the feasibility and efficacy of pharmacological atrial defibrillation in humans.
- To investigate drug delivery via a temporarily occluded coronary sinus near the Vein of Marshall.
Main Methods:
- Six patients with recurrent AF underwent coronary venography.
- Atrial fibrillation was induced by pacing.
- A low dose of propafenone was delivered into the occluded coronary sinus.
Main Results:
- Pharmacological atrial defibrillation with propafenone restored sinus rhythm in 5 out of 6 patients.
- One patient required ibutilide fumarate after propafenone failed.
- The Vein of Marshall's lack of valves may facilitate retroperfusion.
Conclusions:
- Pharmacological atrial defibrillation is feasible and effective using minimal drug doses.
- Delivery near the Vein of Marshall via occluded coronary sinus is a viable method.
- This technique offers potential for developing an implantable pharmacological atrial defibrillator.
Unlabelled:
The aim of this paper is to report the first experience of pharmacological atrial defibrillation in humans via a temporarily occluded coronary sinus.
Patients And Methods:
In 6 patients (3 women, 3 men; mean age 57.8y, min 31, max 71), with clinical recurrences of atrial fibrillation, an occlusive coronary venogram was carried out in order to establish the origin of the Vein of Marshall. Atrial fibrillation was then induced by atrial pacing in all the patients and after an adequate waiting period to assure that the atrial fibrillation episode was persistent and stable, a bolus of a very low dose of an antiarrhythmic drug was delivered in 3-4 seconds into the temporarily balloon occluded coronary sinus near the orifice of the vein of Marshall. For both the venogram and the pharmacological test a Baim-Turi (USCI-Bard, Billerica MA) or a Vueport (Cardima, Fremont CA) catheter was used.
Results And Comments:
In five patients a single dose of 7 mg of propafenone was immediately effective in restoring the sinus rhythm. In the remaining patient 2 doses of 7mg of propafenone failed to interrupt the arrhythmia, which was subsequently interrupted by a bolus of 0.1mg of ibutilide fumarate given after a waiting period of 20 minutes. Retroperfusion of the left atrium could account for these results; in fact the Vein of Marshall has no valvular apparatus in contrast with other coronary sinus tributary veins which are equipped with an uni- or bicuspidal valve.
Conclusions:
Pharmacological atrial defibrillation with a minimal dose of an antiarrhythmic drug delivered near the orifice of the Vein of Marshall via the temporarily occluded coronary sinus is feasible and effective. This new pharmacological atrial defibrillation can offer interesting opportunities in developing an implantable pharmacological atrial defibrillator.
